Motility In Infants Research Articles

Accuracy of clinical indicators of the nursing diagnosis of dysfunctional gastrointestinal motility in infants.

This study aimed to analyze the accuracy of the clinical indicators of the nursing diagnosis of dysfunctional gastrointestinal motility in infants from neonatal units and identify their association with clinical variables. This is a study of the diagnostic accuracy of clinical indicators of the diagnosis of dysfunctional gastrointestinal motility, with a cross-sectional design, performed on 228 hospitalized infants in neonatal units. A high prevalence of dysfunctional gastrointestinal motility was identified in the studied population. Regarding accuracy measures, clinical indicators such as increased gastric residual, changes in bowel sounds, bile-colored gastric residual, regurgitation, absence of flatus, and hard and formed stool were useful to discriminate between infants with and without dysfunctional gastrointestinal motility. The findings can help nurses during the diagnostic process, as they identify which defining characteristics can be used to confirm or rule out the probability of occurrence of the diagnosis.

Characterization of Upper Gastrointestinal Motility in Infants With Persistent Distress and Non-IgE-mediated Cow's Milk Protein Allergy.

Persistent crying in infancy is common and may be associated with gastroesophageal reflux disease (GERD) and/or non-IgE-mediated cow's milk protein allergy (CMPA). We aimed to document upper gastrointestinal motility events in infants with CMPA and compare these to findings in infants with functional GERD. Infants aged 2 to 26 weeks with persistent crying, GERD symptoms and possible CMPA were included. Symptoms were recorded by 48-hour cry-fuss chart and validated reflux questionnaire (infant GERD questionnaire [IGERDQ]). Infants underwent a blinded milk elimination-challenge sequence to diagnose CMPA. GERD parameters and mucosal integrity were assessed by 24-hour pH-impedance monitoring before and after cow's milk protein (CMP) elimination. C-octanoate breath testing for gastric emptying dynamics, dual-sugar intestinal permeability, fecal calprotectin, and serum vitamin D were also measured. Fifty infants (mean age 13 ± 7 weeks; 27 boys) were enrolled. On the basis of CMP elimination-challenge outcomes, 14 (28%) were categorized as non-IgE-mediated CMPA, and 17 (34%) were not allergic to milk; 12 infants with equivocal findings, and 7 with incomplete data were excluded. There were no baseline differences in GERD parameters between infants with and without CMPA. In the CMPA group, CMP elimination resulted in a significant reduction in reflux symptoms, esophageal acid exposure (reflux index), acid clearance time, and an increase in esophageal mucosal impedance. In infants with persistent crying, upper gastrointestinal motility parameters did not reliably differentiate between non-IgE-mediated CMPA and functional GERD. In the group with non-IgE-mediated CMPA, elimination of CMP significantly improved GERD symptoms, esophageal peristaltic function, and mucosal integrity.

Characterization of Esophageal Motility in Infants With Congenital Diaphragmatic Hernia Using High‐resolution Manometry

The aim of the study was to characterize esophageal motility and esophagogastric junction (EGJ) function in infants who underwent repair of an isolated congenital diaphragmatic hernia (iCDH). High-resolution manometry with impedance was used to investigate esophageal motility and EGJ function after diaphragmatic repair in 12 infants with iCDH (11 left-sided; 9 patch repair). They had esophageal motility studies during neonatal admission (n = 12), at 6 months (n = 10) and at 12 months of life (n = 7). Swallows were analyzed using conventional esophageal pressure topography and pressure flow analysis and were compared with 11 healthy preterm born infants at near-term age. Esophageal peristaltic motor patterns in patients with iCDH were comparable to controls. EGJ end-expiratory pressure was higher in patients with patch repair compared with controls (P = 0.050) and those without patch (P = 0.009). The difference between inspiratory and expiratory pressures at the EGJ was lower in patients with iCDH with patch (P = 0.045) compared to patients without. Patients with iCDH with patch showed increased Pressure Flow Index, resistance of bolus flow at the EGJ, compared with controls (P = 0.043). Normal esophageal wave patterns are present in the investigated patients with iCDH. EGJ end-expiratory pressure seems lower in patients with iCDH without patch suggesting a decreased EGJ barrier function hence increased vulnerability to gastroesophageal reflux. Patch repair appears to increase end-expiratory pressure at the EGJ above that of controls suggesting that patch surgery tightens the EGJ, thereby increasing flow resistance. This is in line with the increased Pressure Flow Index. In infants with a patch, the inspiration-expiration pressure difference is lower, reflecting diminished activity of the crural diaphragm.

Vomiting and gastric motility in infants with cow's milk allergy.

Vomiting and gastric motility in infants with cow's milk allergy.

Vomiting and gastric motility in infants with cow's milk allergy.

Regurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting. Seven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5-2.4 cycles per minute [cpm], normogastria = 2.5-3.9 cpm, tachygastria = 4.0-9.0 cpm) and the postprandial-to-fasting power ratio of gastric electrical activity, whereas gastric half-emptying time (T1/2) was measured by electrical impedance tomography (EIT). In CMPA and GER, respectively, during fasting, the frequency distribution (mean +/- SD) of the EGG was as follows: normogastria 47.9%+/-12.5% versus 52.2%+/-9.8%, bradygastria 24.1%+/-5.7% versus 22.8%+/-8.3%, and tachygastria 28.0% 8.5% versus 25.0% 8.3%. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1%+/-8.8% versus 70.6%+/-8.6% (P < 0.0001). bradygastria 38.0%+/-15.5% versus 15.7%+/-5.2% (P = 0.002), and tachygastria 28.9%+/-10.6% versus 13.4%+/-4.6% (P = 0.001. The postprandial/ fasting power ratio (mean +/- SD) was 3.2+/-1.9 in CMPA and 8.1+/-2.1 in GER (P < 0.0001). Gastric T1/2 (mean +/- SD) of the cow's milk meal was 89.0+/-26.3 minutes versus 54.0+/-12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T1/2 were similar to that in 10 healthy control infants. In sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.

Vomiting and Gastric Motility in Infants With Cow's Milk Allergy

ABSTRACTBackgroundRegurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting.MethodsSeven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5—2.4 cycles per minute [cpm], normogastria = 2.5–3.9 cpm, tachygastria = 4.0–9.0 cpm) and the postprandial‐to‐fasting power ratio of gastric electrical activity, whereas gastric half‐emptying time (T½) was measured by electrical impedance tomography (EIT).ResultsIn CMPA and GER, respectively, during fasting, the frequency distribution (mean ± SD) of the EGG was as follows: normogastria 47.9% ± 12.5% versus 52.2% ± 9.8%, bradygastria 24.1% ± 5.7% versus 22.8% ± 8.3%, and tachygastria 28.0% ± 8.5% versus 25.0% ± 8.3%. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1% ± 8.8% versus 70.6% ± 8.6% (P &lt; 0.0001), bradygastria 38.0% ± 15.5% versus 15.7% ± 5.2% (P = 0.002), and tachygastria 28.9% ± 10.6% versus 13.4% ± 4.6% (P = 0.001. The postprandial/fasting power ratio (mean ± SD) was 3.2 ± 1.9 in CMPA and 8.1 ± 2.1 in GER (P &lt; 0.0001). Gastric T½ (mean ± SD) of the cow's milk meal was 89.0 ± 26.3 minutes versus 54.0 ± 12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T½ were similar to that in 10 healthy control infants.ConclusionsIn sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.

NON-INVASIVE ASSESSMENT OF GASTRIC MOTILITY AND GASTRIC EMPTYING IN VOMITING CHILDREN WITH DISORDERS OF THE CENTRAL NERVOUS SYSTEM.

Vomiting and feeding problems are common in children with disorders of the central nervous system (CNS) and may be related to a disordered motility of the foregut. The conventional tools for assessing foregut motility are either invasive (e.g. pH monitoring and manometry) or very expensive and time-consuming (e.g. scintigraphy) and therefore they are not ideal for general use in neurologically handicapped infants and children. We studied gastroesophageal motor function in 50 vomiting patients with CNS disorders, 25 boys and 25 girls (age range: 4 months - 15.5 years), 38 with neurodevelopmental delay and 12 with spastic cerebral palsy. The novel non-invasive techniques of electrogastrography (EGG) and electrical impedance tomography (EIT) were used to investigate respectively the fasting and postprandial gastric antral electrical control activity that underlies antral contractions and the gastric emptying of a standard milk meal. In most cases, EGG and EIT were carried out simultaneously after an overnight fast at the bedside or while the patients were sitting in their wheelchairs. All tests were very well tolerated, and in some patients the tests were repeated after medical or surgical treatment. In 31 of 50 vomiting patients EGG detected abnormalities of gastric antral electrical control activity, with different dysrrhythmias: tachyarrhythmia at >5 cpm, bradyarrhythmia at <2 cpm, or unstable electrical activity where no dominant frequency could be detected (controls: 2.2 to 4.0 cpm). EIT showed that the gastric half-emptying time (T½) of a milk meal was delayed in 14 of 18 patients, 13 of whom also had a gastric dysrhythmia and 8 of whom also had gastroesophageal reflux. Gastric dysrryhtmias and/or delayed gastric emptying were also demonstrated in the majority (72%) of patients who had retching and postprandial discomfort following anti-reflux surgery. Furthermore, EIT showed evidence of gastroesophageal reflux in 12 of 13 patients who had reflux on pH monitoring. Being non-invasive, relatively cheap, portable and easy to use, EGG and EIT can be used for the routine assessment of gastrointestinal motility in infants and children with neurodevelopmental handicap. The informations they provide can help the carers to devise better nutritional and pharmacological strategies for the management of vomiting and feeding problems which are frequently encountered in these patients.

Gastroesophageal motility in infants with gastric volvulus

Gastroesophageal motility in infants with gastric volvulus

Effects of domperidone therapy on symptoms and upper gastrointestinal motility in infants with gastroesophageal reflux

We evaluated the effect of domperidone, a novel prokinetic agent, on symptoms and esophageal and gastric motility in 15 infants (six boys), mean age 7.9 months, with moderate to severe gastroesophageal reflux (GER) and upper gastrointestinal motility disturbances. Patients received domperidone orally for 6 weeks and underwent weekly assessment of five GER-associated symptoms, weight change, and side effects. Mean total symptom scores significantly improved after treatment (P less than 0.01). Vomiting, "spitting," and coughing each improved significantly. Postprandial reflux time (defined as esophageal pH less than 4.0) and percent peristaltic esophageal contractions improved significantly (p less than 0.05). Gastric fundic contractions, present in only four infants before treatment, occurred in nine after domperidone administration. Although mean gastric emptying of isotope-labeled formula was not improved, it improved greater than or equal to 10% over baseline in nine patients. Peristaltic amplitude, lower esophageal sphincter pressure, and esophageal acid clearance time were unchanged. Side effects were minimal. We conclude that domperidone is a useful and safe agent for treatment of gastroesophageal reflex in infants because it addresses the motility abnormalities inherent in the pathophysiology of the disorder.

Nonmigrating Rhythmic Activity in the Stomach and Duodenum of Neonates

We studied gastrointestinal motility in 20 infants, using a modified manometric method for neonates, and compared it to that in adults. Changes in the intragastric and intraduodenal pressures were recorded for 3 h after the ingestion of milk. Bands of contractions with the same rhythmicity as phase III activity in adults were frequently recorded. Some of them migrated caudally and were speculated to the equivalent of phase III activity of the interdigestive migrating complex (IMC) in adults. However, others did not migrate and showed some differences from phase III activity of adults and infants in the time of occurrence, duration and amplitude. The characteristic of gastroduodenal motility in infants was the frequent occurrence of these bands of nonmigrating rhythmic concentrations. Our findings indicated the following problems: (1) there are some differences in gastrointestinal motility between infants and adults and further investigations are required for the evaluation of the physiology or pathophysiology of this phenomenon; (2) in infants, many bands of rhythmic contractions of the alimentary tracts can exist without migration. This indicates the possibility that the occurrence of rhythmic contractions and their migration are regulated by different mechanisms.

Esophageal Motility in Infants of Esophageal Atresia and in Dogs with Extrinsic Denervation of the Esophagus

Esophageal Motility in Infants of Esophageal Atresia and in Dogs with Extrinsic Denervation of the Esophagus

Manometric studies of esophageal motility in infants with hiatus hernia.

Manometric studies of esophageal motility in infants with hiatus hernia.

PERFORMANCE EXPECTANCY AS A DETERMINANT OF ACTUAL PERFORMANCE: DISSONANCE REDUCTION OR DIFFERENTIAL RECALL?

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Esophageal motility in infants and children

Patterns of esophageal motility are presented, and normal values are established in 47 normal infants and children between 2 days and 14 years of age. The tone of the inferior esophageal sphincter mechanism is poor during the first 6 days of life, but increases significantly after the first week and through the first year of life. In the majority of children the inferior esophageal sphincter mechanism is located at or above the level of the effective diaphragmatic hiatus, and an intra-abdominal segment cannot be demonstrated. A progression of peristaltic waves from the esophagus into the fundus of the stomach is noted in children less than 2 years old. This is not found in older children or in adults. Inferior esophageal sphincter tone, relative to intragastric pressure, is poor in infants with regurgitation and with pyloric stenosis. These occur rhythmically and measure 5 to 35 mm Hg in height.

Esophageal Motility in Infants and Children

Patterns of esophageal motility are presented, and normal values are established in 47 normal infants and children between 2 days and 14 years of age. The tone of the inferior esophageal sphincter mechanism is poor during the first 6 days of life, but increases significantly after the first week and through the first year of life. In the majority of children the inferior esophageal sphincter mechanism is located at or above the level of the effective diaphragmatic hiatus, and an intra-abdominal segment cannot be demonstrated. A progression of peristaltic waves from the esophagus into the fundus of the stomach is noted in children less than 2 years old. This is not found in older children or in adults. Inferior esophageal sphincter tone, relative to intragastric pressure, is poor in infants with regurgitation and with pyloric stenosis. These occur rhythmically and measure 5 to 35 mm Hg in height.

Motility in Infants, Children, and Adults

Motility in Infants, Children, and Adults

MOTILITY IN YOUNG INFANTS

An important question in studies of motility in infants is concerned with the conditions of motility; that is, what factors affect motility? Among possible conditions are: nutritional status, hunger, the waking state, body temperature, pain, weight, size, bone development, calcium and creatinine output and amount of blood sugar before and after activity. The specific problem to be discussed here is what is the relation of body temperature in young infants to their motility? The subjects used in this study were sixty-six infants under 16 days of age who were born in the obstetric department of the Iowa State University Hospital. The apparatus for measuring motility—a Pratt experimental cabinet, a two-dimensional stabilimeter giving a relative measure of motility and a polygraph—together with the methods used have been described elsewhere.1The unit of motility is the number of oscillations (o/m) of the polygraph recording pens per minute. Rectal temperatures were recorded

GASTRIC MOTILITY IN INFANTS AS SHOWN BY THE ROENTGEN RAY

The study of the stomach from radiographs, taken at frequent intervals after the introduction of bismuth in the regular feeding, offers a new and interesting method of observing gastric motility in infants. It is a subject which has a very important bearing on many of the questions which arise in connection with infant feeding, but we have at present very little accurate knowledge either of normal or abnormal motility in the gastric digestion of infants, as shown by this method of investigation. The prevailing view expressed in text-books is that the infant's stomach empties itself in about two hours in breast-fed babies, and in three hours in artificially-fed babies. This opinion has been based on the results of the examination of the stomach contents obtained by siphonage. Dr. Walter B. Cannon of Harvard was one of the first to study in animals gastric motility by means of the fluoroscope. With